Developing a Psychiatry Care Partner Program

Developing a Psychiatry Care Partner Program
By Kathleen Friedman, LCSW-R, CSC; Director, Deaf and Hard of Hearing Clinic; Michelle Gabriele, LCSW-R, Social Work Supervisor, Geriatric Clinic; Barbara Waltman, LCSW-R; Director of Social Work
New York-Presbyterian Hospital/ Westchester Division

Care Partner Programs are widely recognized by Planetree and its medical hospital affiliates as the gold standard for involving patients’ families and loved ones in their care, creating a truly patient and family centered experience. When developing a Care Partner Program for psychiatry, the Family Engagement Committee at New York-Presbyterian Hospital/Westchester Division, examined how families are currently involved during the hospitalization and explored how we can adapt the traditional Care Partner Program to benefit our families, patients and Hospital. In particular, we looked at what would make a Care Partner Program in psychiatry different, helpful, and also deliver improved outcomes.

Empowering Families and Caregivers

The emotional and physical toll of being a caregiver to a person with mental illness can be strenuous. Psychiatric disorders are often chronic illnesses, with repeated episodes of dysfunction. This can have a ripple effect on those family members who provide emotional support and encouragement on a daily basis to loved ones who may lack insight into the need for treatment and services. Families may be confronted with episodes of emotional instability, intense anger and rejection directed at them. The rate of burn-out in these families is disproportionately high. We recognized that a primary goal of our psychiatric Care Partner Program needed to be empowering families and caregivers by offering concrete skills, education and encouragement to cope with the impact of psychiatric illness on the family. We also anticipated that by increasing the family’s knowledge, we would be able to help them cope with the stigma that unfortunately continues to be associated with mental illness and that brings additional challenges to caregiving for a person with a mental illness.

Drawing on Families’ Knowledge of Their Loved One

Because of the compromised mental state experienced by some psychiatric patients during an acute episode of illness, there may be an increased risk that they will not be reliable historians about their course of illness and symptoms. Families’ knowledge about patient health, psychiatric history, barriers to treatment and recovery are invaluable tools to the treatment teams in developing realistic treatment and discharge plans. Our goal for the psychiatry Care Partner Program was to provide validation to families by respecting their expertise and experience and to actively involve them in decision making. By enlisting families as knowledgeable experts in their loved ones’ struggle with mental illness, our Care Partner Program would provide help to overcome barriers to treatment and offer hope for continued recovery.

Engaging Family as Integral Participants in the Patient’s Journey Toward Recovery

At New York-Presbyterian Hospital/Westchester Division, we view our Care Partners as integral participants in the patients’ and families’ journey towards recovery.  Within the medical model of Care Partner Programs, family participation is organized around the delivery of patient care at Hospital bedside. Our Family Engagement Committee determined that in a psychiatric Care Partner Program, families needed to be engaged as active participants where psychiatric treatment occurs, the rehabilitative milieu on the unit.

Activities and elements of the Care Partner Program were identified with the understanding of the types of challenges that psychiatric patients and their families face. The involvement of families in our clinical groups and activities has become the cornerstone of our Care Partner Program. With patient consent, families are invited to unit groups, attended by patients and families together, where they can learn about psycho-educational topics such as diagnoses, treatment, warning signs of relapse, how to intervene at critical times to prevent re-hospitalization and the development of healthy coping skills. Additionally, they are afforded the opportunity to gain a better understanding of the patient experience, perspective and struggle.  On several units, we have begun to include families in clinical rounds where they can provide input, be directly involved in their loved ones’ treatment and discharge planning and ask questions of the treatment team. In this way, our Care Partner Program creates a true partnership between patients, loved ones and the clinical staff.

Other examples of psychiatry Care Partner activities include medication education both in psycho-educational groups and in individual meetings with treatment team members. While both medical and psychiatric patients can struggle at times with treatment compliance, for our patients, non-compliance can become a function of the psychiatric illness.  Care Partner involvement can have a significant impact on a patient’s ability to follow through with medication compliance and discharge plans, reducing the risk of re-admission.  Care Partner participation in safety planning meetings also increases the possibility of improved outcomes.

Leisure activities on a psychiatric unit are an important component of the milieu rehabilitative process, where interactions with peers occur daily, due to the nature of a psychiatric length of stay. Patients and Care Partners are encouraged to participate together in activities such as pet therapy, yoga, meditation, and aromatherapy, games and arts and crafts. These leisure activities provide opportunities for normalized socialization and enhance the development of positive relationships between patients and Care Partners that will endure post-discharge and support the mutual task of maintaining well-being.

Our Vision

As the first psychiatric Hospital to receive Planetree designation, the New York-Presbyterian Hospital/Westchester Division Care Partner initiative has built upon the many medical models offered throughout the Planetree network. As a pioneer in the development of a psychiatric Care Partner Program, we are proud to provide families and friends with new opportunities to participate in patient care. Our hope is that our Care Partner Program will advance understanding of psychiatric illness and recovery, reduce stigma attached to psychiatric disorders and increase patient and family strengths and competence. Our vision is for our psychiatric Care Partner Program to promote healing and recovery for every patient beyond the hospitalization as they return to their homes and communities.

For further questions about the New York-Presbyterian Hospital/Westchester Division Care Partner program please contact Barbara Waltman, LCSW-R at bwaltman@nyp.org.